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Premature Infant 




  • Altered airway anatomy

  • Other physiologic derangements of prematurity:

    • Pulmonary: respiratory distress syndrome, bronchopulmonary dysplasia, rapid desaturaiton, post-op apnea, persistent pulmonary hypertension 

    • Cardiovascular: HR/preload dependant cardiac output, transitional circulation/PDA, bradycadia, congenital heart disease 

    • CNS: intraventricular hemorrhage, seizures, retinopathy of prematurity, apnea

    • GI: GERD, NEC

    • Metabolic: Impaired temperature & glucose regulation

    • Hematology: anemia, thrombocytopenia

  • Altered pharmacology:

    • ↑ volume of distribution 

    • Opioid sensitivity

    • ↓ clearance, protein binding, metabolism, ↓ MAC

    • Immature renal & hepatic function 

  • Difficult IV access

  • Post op apnea monitoring





  • Ensure optimization of multisystem derangements including respiratory, cardiovascular, hepatic, renal, hematological

  • Anticipate fluid, electrolyte, glucose derangements, & optimize preoperatively

  • Ensure continuous temperature monitoring & maintain normothermia







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